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Mediclinic News : Obstetricians flee in face of legal claims

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Obstetricians flee in face of legal claims

Date

2016-09-04

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SUNDAY TRIBUNE The fear of being sued for medical negligence and the high cost of indemnity from legal claims has resulted in a countrywide trend of obstetricians leaving the child delivery profession. In the past six months, five obstetricians practising privately in the northern areas of Durban gave up the speciality in medicine. Medics believe the number of obstetricians leaving will be significantly higher, nationally, next year. By the end of this year, most South African obstetricians in private practice would have paid R650 000 for indemnity cover, as members of popular UK based non-profit organisation Medical Protection Society (MPS). But MPS fees for protection cover next year are set to cost approximately R1 million, which has to be paid in 10 monthly instalments. The average cost of cover for obstetricians was almost R4000 a year in 2000, said Dr Siva Moodley, a council member of the Durban Obstetrics and Gynaecological Society. "Obstetrics is in a state of crisis, more doctors will leave this profession," Moodley said. He said while experienced obstetricians were bowing out, fewer registrars at universities were choosing obstetrics as their field of speciality. He heard from a reliable source that 58 registrars filled posts at the University of KwaZuluNatal in 2014, but only 24 were specialising in obstetrics at present. But University of KwaZuluNatal's executive director, Lesiba Seshoka, said their numbers of registrar applications remained consistent. Moodley claimed lawyers were largely to blame for obstetrics becoming unpopular and the sharp increase in insurance costs. "In the past, lawyers raided the Road Accident Fund (RAF) with claims they made, on behalf of clients, until government clamped down on loopholes in the (RAF) system. Medical malpractice is now the niche market lawyers are focused on because of the large lump sum pay-outs that could be collected. "Damages claims against obstetricians averaged around R30m and were usually made when babies were born with abnormalities, patients sustained surgical injuries or the death of some." Moodley said lawyers marketed their services aggressively for medical malpractice claims through many mediums. They offer to do legal work on a contingency basis and usually pocket as much as a third of the pay-out. "Lawyers even have touts at hospitals and medical centres to alert them to potential clients." Moodley said the greater number of claims against obstetricians had caused the steep rise in indemnity costs. But Dr Graham Howarth, Head of MPS Africa said their tariff increases were justified. "As a responsible, not for profit organisation, we need to reflect the increasing cost of clinical negligence claims in our membership subscriptions. Our data indicated the estimation of the long term average claim frequency for doctors in 2015 is around 27 percent higher than in 2009. "Our concern is that this trend may continue, with increasing claim sizes forcing us to raise subscription costs." To survive in the obstetrics trade, Moodley said obstetricians were forced to charge higher co-payments, in spite of delivery fees received from medical aid companies. The co-payments help doctors to pay insurance and other bills." With the threat of litigation constantly looming, obstetricians were forced into practising "defensive medicine", Dr Moodley suggested. "Obstetricians are more likely to deliver babies by Caesarean Section at the slightest sign of complications before or during delivery" Moodley said it was not more lucrative to do C-Section deliveries. "We get paid a few hundred rand more for a vaginal birth (R3 260) than a C-Section delivery (R3087)." Disillusioned with the way things are, Dr Adrian Payne, who is based in Hillcrest, plans to quit in November. "I have about 35 years' experience in obstetrics. I'll focus on gynaecological work in future." Payne said the longer hours, high insurance premiums and the threat of being sued forced his decision. "I'm 55 years old. If I remain in practice for another 10 years, with escalation, I would have to pay about R46m for insurance in that time. "I am disappointed that I have to give it up, but now I'll focus solely on the other half of my speciality" he said. Dr Chris Archer, chief executive of SA Private Practitioners Forum (SAPPF) and chairman of the Gynaecological Management Group, said four Worcester obstetricians would not be taking patients in 2017. "Five obstetricians at the Netcare Park Lane in Johannesburg... will drop out at the end of the year. The talk of premiums shooting through the roof next year is scaring them," Archer said. With fewer obstetricians in private practice, Dr Sagie Naidoo, general secretary of the SA Society of Obstetricians and Gynaecologists (Sasog) said it would force patients to rely more heavily on government run facilities for child birth. Naidoo said he had seen statistics that showed R25 billion in medical negligence claims were made against the Department of Health, in the 2015/16 term, and R5bn of that total was for obstetrics matters. "More patients relying on the state are bound to result in more claims, which would result in more of the government's budget used for claims, instead of health care." Noel Desfontaines of trade union Hospersa agreed with Naidoo. Desfontaines said the general shortage of doctors, nurses, equipment and drugs often experienced in hospitals, as well as the pressure the doctors work under in public institutions meant "the margin of error is high". He also claimed lawyers had shifted their focus and found it easier and more lucrative to sue doctors for malpractice. The Co-Chairs of the Law Society of South Africa, Mvuso Notyesi and Jan van Rensburg said in a joint statement that victims of medical negligence had the right to legal representation and to be compensated fairly for their losses. "Legal practitioners cannot 'manufacture' malpractice injuries these are substantiated by experts and confirmed by the court when a claim is finalised in court. "If there are allegations of touting or collusion involving attorneys, the law society will investigate claims." afford to practise their speciality, writes Mervyn Naidoo.
Created at 2016/09/15 08:35 AM by Mediclinic
Last modified at 2016/09/15 08:35 AM by Mediclinic